De-escalation of the systemic therapy in advanced colorectal cancer - justified clinical practice from the point of view of efficiency and safety

Abstract

Colorectal cancer is one of the most frequent malignant tumours in Poland, making up the third cause of cancer deaths both in women and in men with regards to the frequency of occurrence. The therapy of patients with high-stage colorectal cancer is palliative and should be conducted in a continual manner until the disease progression or unacceptable toxicity of treatment. By definition, palliative care aims at prolongation of the period to the exacerbation of the disease and of the overall survival with simultaneous guarantee of appropriate quality of life to the patients. A long-term use of a multidrug chemotherapy is often connected with the presence of clinically significant toxicity, therefore, de-escalation of systemic treatment is currently the subject of numerous analyses. The studies evaluating the effect of maintenance therapy on patient survival, prove that this kind of treatment makes up a valuable option in the case of patients in whom a good clinical effect is maintained with a concurrent reduction of toxicity of treatment. Especially in the context of the ongoing SARS-CoV-2 pandemic, monotherapy or less aggressive therapy should be discussed with patients.